10 tips for health insurance open enrollment

Wedged in between Halloween and Thanksgiving is health insurance open enrollment season for many employees. That means it's time to review health benefits and pick what plan to enroll in for next year.

This year, things are a little different in light of the health reform bill signed into law in March. So we consulted Optima Health and Anthem Blue Cross and Blue Shield for these health insurance open enrollment tips.

Expect premiums to go up. Optima Health estimates a 1 to 4 percent increase to the base rates of large group plans and a 2 to 3 percent hike for small group and individual plans. This reflects the added medical expenses of providing coverage of dependents up to age 26, the elimination of member cost sharing on preventive services and other new mandates. At Anthem, premiums increases on average are in the mid-single- to low double-digit range, said Scott Golden, an Anthem spokesman.

If you want to enroll your child up to age 26 on your plan, you have 30 days during open enrollment to do so, Optima Health said. Depending on the type of coverage the consumer may have, adding adult children may have an impact on premiums, Anthem said.

How do you pick a plan that's right for you? First, list last year's healthcare expenses — doctor's visits, prescriptions, hospital stays, outpatient procedures, eye care, dental, screenings, etc., Optima Health says. Second, assess your family's healthcare needs for the coming year. Do you anticipate needing surgery or other procedures, orthodonture or an increase in prescriptions or doctor's visits? Planning to have a baby? Third, make a list of your physicians and providers. Check whether they still fall into the health plan's network. Fourth, look at your budget and determine what you can afford to pay per pay period for health insurance.

You may want to consider a high-deductible, Consumer-Driven Health Plan (CDHP) over traditional HMO and PPO options, Anthem advises. CDHPs include Health Savings and Health Reimbursement accounts, giving you more control on how you spend your health care dollars. Enrollees who choose CDHPs may also receive financial rewards for completing wellness programs. In a CDHP, you pay lower premiums monthly, knowing that you'll pick up a bigger share of the tab when services are used. The number of Optima members on these plans is low — about 6.5 percent — but the plans are gaining popularity, said John DeGruttola, senior vice president of sales and marketing for Optima Health. In 2008, there were about 1,500 members on CDHPs. Now, there's close to 18,000. "It's (for) someone who can save money and actually can outlay higher amounts of money when the services are needed," he said.

Health Savings Accounts are typically available with high-deductible plans and are for qualified medical expenses, including hospitalizations, physician services, dental, vision and occupational therapy, DeGruttola said. Funds contributed to the account are not subject to federal taxes going in or coming out. Anything saved at the end of the year is rolled over for future expenses, or even into retirement, perhaps for long-term care. If you withdraw money not for medical expenses, you pay an excise tax of 20 percent under health reform. "They're people who basically know the kind of services that they need, they're savers, and they want to take ownership of their healthcare," he said.

Health reimbursement accounts are like health savings accounts, except they're employer based. The employer develops the plan design and could share in some of the expenses of the high-deductible plan. The employer could roll over the balance on behalf of the employee, DeGruttola said.

Flexible Spending Accounts. With dependent care FSAs, consumers contribute a portion of your before-tax income to a spending account to help pay for childcare and other dependent care expenses, Anthem says. Health care FSAs are similar, but help you pay for health care expenses, like co-pays and prescriptions. But reimbursement changes are coming for health care FSAs. For example, beginning in 2011, over-the-counter drugs will no longer be reimbursed. Optima Health doesn't offer flexible spending accounts.

Health reform is being phased in, which means not all changes may apply at once. Most people will see preventive services covered without any cost, in- and out-of-network emergency services covered at the same rate and dependents younger than 26 able to be added to their policies at their renewal. But, for example, employer plans with "grandfathered" status may not allow members to enroll children up to age 26 if the young adult has another source of employee-sponsored insurance, DeGruttola said.

Review your enrollment materials even if you're not changing health plans. Benefits can change year to year and it is important to know how these changes may affect you, Golden said.

Find more health news at dailypress.com/healthnotes, facebook.com/dphealth and twitter.com/veronicachufo.

Insurance Web chat Wednesday

Here's your chance to ask questions about health insurance. Join us Wednesday at noon at dailypress.com as we chat with Optima Health's John DeGruttola and representatives of Anthem Blue Cross and Blue Shield.